PTH-026 Evaluation of a Service to Manage Inflammatory Bowel Disease (IBD) in Pregnancy

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Abstract

Introduction

Following the publication of a consensus for management of IBD in pregnancy a service was set up in our institution (April 2013) to optimise the management of pregnant women with IBD. Its’ aim is to enable multidisciplinary management of patients with a consultant gastroenterologist, consultant obstetrician, colorectal surgeon and IBD specialist nurse. It provides a baseline health check in the early stages of pregnancy, more intensive foetal growth monitoring with additional growth scans at 28 and 32 weeks of pregnancy, discussion of delivery methods and anticipation of potential peripartum problems including liaison with colorectal surgical team. A review of the service was performed after 8 months to provide an overview of management of patients, demand and outcomes following set up of the service.

Methods

A retrospective review of medical notes was performed of patients seen in the clinic. Information was gathered on diagnosis, previous surgery for IBD, parity, outcomes of previous pregnancies, medication preconception and during pregnancy, disease activity preconception and during pregnancy and outcome of pregnancy.

Results

Data was collected on 20 patients. 8 had Crohns disease (CD), 12 had ulcerative colitis (UC). Surgery: In the UC group 3/12 had previous surgery:2 ileoanal pouch, 1 subtotal colectomy. In CD group 4/8 had an ileocolonic resection. Parity: 5=para 1, 8=para 2, 6=para 3, 1=para 4. Medication: 11/20 were on no medication (6 UC, 5 CD). 3 were on infliximab, last infusion 20/40, 3 were on azathioprine, 5 were on a 5ASA. Disease activity: 19/20 were well preconception, 1 was unwell around time of conception (miscarriage at 11/40). 10/20 had a flare of disease activity during pregnancy: 1 settled with topical treatment, 1 settled with 5ASA, 8 required oral steroids. All 3 patients on infliximab had a flare after stopping it and required oral steroids. 1 of these had a stillbirth shortly after commencing steroids for a flare. Outcomes: 10/20 have not yet delivered, 3 are planned for elective CS (1 perianal disease, 1 previous CS, 1 previous forceps delivery). 3 had CS (2 had ileoanal pouches and 1 had perianal disease), 1 stillbirth, 1 miscarriage, 5 had normal vaginal delivery (NVD). No preterm births or low birth weights reported.

Conclusion

Those with ileoanal pouches and perianal disease are being appropriately considered for a planned CS. 50% of our patients have a NVD which as expected is lower than the general population. 50% of our patients had a flare in disease during pregnancy which is higher than literature (30%)1. 80% required oral prednisolone to settle and both adverse outcomes appear to be related to a flare in disease. Those on infliximab appear to be at high risk of flaring after their last dose around 20 weeks.

Reference

1 Janneke van der Woude et al. J Crohns Colitis 2010:4:493–510

Disclosure of Interest

None Declared.

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